Quality standard

Quality statement 4: Acute complications

Quality statement 4: Acute complications

Quality statement

People with an acute painful sickle cell episode are assessed for acute chest syndrome if they have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

Rationale

Acute chest syndrome is a major cause of morbidity and mortality in people with sickle cell disease. It can progress rapidly and is not always recognised as a possible complication. Monitoring by clinical assessment, acting on any changes and assessing for acute chest syndrome may lead to this complication being identified and treatment started earlier.

Quality measures

Structure

a) Evidence of local arrangements to ensure that healthcare professionals caring for people with an acute painful sickle cell episode are aware of acute chest syndrome as a potential complication.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that people with an acute painful sickle cell episode are assessed for acute chest syndrome if they have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

Data source: Local data collection.

Process

Proportion of people with an acute painful sickle cell episode with 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia who are assessed for acute chest syndrome.

Numerator – the number of people in the denominator who are assessed for acute chest syndrome.

Denominator – the number of people with an acute painful sickle cell episode who have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that healthcare professionals caring for people with an acute painful sickle cell episode are aware of acute chest syndrome as a potential complication and that people with an acute painful sickle cell episode need to be assessed for acute chest syndrome if they have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

Healthcare professionals ensure that they are aware of acute chest syndrome as a potential complication of an acute painful sickle cell episode and assess for acute chest syndrome if people have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

Commissioners ensure that they commission services that have staff trained to recognise acute chest syndrome as a potential complication of acute painful sickle cell episode and to assess for acute chest syndrome if people with an acute painful sickle cell episode have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

People with a painful attack of sickle cell disease (acute painful sickle cell episode) who have any breathing problems, chest pain or fever are assessed for a serious lung condition called acute chest syndrome.

Definitions of terms used in this quality statement

Signs and symptoms of hypoxia

  • Oxygen saturation of 95% or below, or

  • An escalating oxygen requirement to maintain oxygen saturations of 95% or above.

Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes. [NICE's guideline on sickle cell disease, recommendation 1.1.19]